Health & Welfare Plans Newsletter

February 21, 2020

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[Official Guidance]

Editor's Pick Text of IRS Chief Counsel Memorandum 20200801F: Statute of Limitations for Section 4880H (PDF)

"Because there is no return that contains the necessary data to calculate the amount of an ESRP that could be owed by an ALE, there is no statute of limitations for the ESRP under section 6501(a). The filing of the required information returns (Forms 1094-C and 1095-C) is insufficient to begin the running of the statute of limitations because they do not contain sufficient data to calculate the amount of the ESRP that would be owed ... As Congress provided no other limitations period for assessing the ESRP, there is none that is applicable." [Dated Dec. 26, 2019; released Feb. 21, 2020]

Internal Revenue Service [IRS]

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Health Reimbursement Arrangement [HRA] Update

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Apr. 2 webinar will review the benefits of establishing an Individual Coverage HRA or an Excepted Benefit HRA and provide you with what you need to know to establish one or both of them. BenefitsLink discountLearn more


[Guidance Overview]

Compliance Aspects of Employer-Sponsored Wellness Programs (PDF)

"[T]he ACA made significant changes to HIPAA's requirements when it modified the categories of wellness programs, changed the rules applicable to some wellness programs, and increased the maximum permissible incentive. The [ADA] and [GINA] also modified the rules for wellness programs, but these two laws also apply to wellness programs that are not health plans and not related to health plans.... [O]ther federal rules including COBRA, ERISA, FMLA, ADEA, cafeteria plan rules, and tax rules may affect how wellness programs are designed and administered. In some cases state laws ... may also apply."

Gallagher

[Guidance Overview]

Editor's Pick Commuter Benefits: A Summary of Local and State Mandates

"An increasing number of jurisdictions around the country ... are mandating that employers provide commuter benefit programs that allow employees to pay for commuting costs on a pre-tax basis. While the requirements are similar across most jurisdictions, there are specific rules for which employees are covered under the different laws and other key distinctions." [A chart summarizes requirements for several local California jurisdictions; Seattle, WA; the State of New Jersey, and the District of Columbia.]

McDermott Will & Emery

[Guidance Overview]

New Jersey Finalizes Paid Sick Leave Rules

"[T]he final regulations do not require employers to establish a single benefit year (e.g., based on the calendar year) for all employees.... Employers may use existing PTO policies or PTO banks to satisfy ESLL requirements -- but only if they conform to all ESLL requirements, 'including the carry-over requirements, relative to all of the PTO.' ... The final regulations recognize that employers may prohibit employees from using earned sick leave on certain dates -- but only when the need to use leave is foreseeable and employees had reasonable notice of the blackout dates."

Buck

Texas at the Supreme Court: The Latest

"[T]he plaintiffs in Texas -- now 18 Republican state attorneys general and two individuals -- filed a conditional cross-petition with the Court on February 14.... [T]he plaintiffs want the Court to deny the cert petitions from California and the House. They maintain that position and restate many of the same arguments in their cross-petition." [U.S. House of Representatives v. Texas, No. 19-481 (cert. pet. filed Jan. 3, 2020)]

Katie Keith, in Health Affairs

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At a Glance: HSAs and Investing (PDF)

Infographic. "HSAs with invested assets had significantly higher balances at the end of 2018 than accounts without invested assets when examining those accounts by the year in which the account was opened.... Both investors and non-investors used the HSA to self-fund medical expenses."

Employee Benefit Research Institute [EBRI]

CMS Reports and Research on Prescription Drug Pricing

"[CMS] estimates that in 2019, $360.3 billion will be spent on retail prescription drugs (net of rebates), rising from $265.2 billion in 2013.... ASPE has conducted research into the magnitude of the recent rise in prescription drug spending, the relative importance of various factors that underlie it, and the contribution of drug spending to the overall rise in health care spending in recent years."

Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS]

Drug Firms' Payments and Physicians' Prescribing Behavior in Medicare Part D (PDF)

"[P]hysicians increase prescribing of drugs for which they receive payments in the months just after payment receipt ... [T]hose receiving payments prescribe lower-quality drugs following payment receipt, although the magnitude is small and unlikely to be clinically significant.... [In] five case studies of major drugs going off patent [physicians] receiving payments from the firms experiencing the patent expiry transition their patients just as quickly to generics as physicians who do not receive such payments."

National Bureau of Economic Research [NBER]; purchase required for full document

How Administrative Spending Contributes to Excess U.S. Health Spending

"Given that administrative spending is high but does not seem to be rising faster than the rest of health care spending, is this a fruitful area for intervention to moderate spending growth? [This article summarizes] highlights of the council's discussion on this matter."

Council on Health Care Spending and Value, Health Affairs

Update on Federal Surprise Billing Legislation: New Bills Contain Key Differences

"Like the December compromise package, the new proposals ensure that consumers will not face surprise bills beyond what they'd pay in cost-sharing for in-network providers. The proposals differ, however, in how they establish what insurers will pay out-of-network providers. The Ways and Means bill relies on voluntary negotiation backed up by independent dispute resolution (IDR) and thus aligns more closely with the approach advocated by hospitals and physician groups. The Education and Labor bill follows the approach in the December proposal by creating a payment standard with a backup IDR process -- thereby attempting to bridge the gap between health care providers and insurers."

The Commonwealth Fund

Benefits in General

Insurer Must Defend ERISA Claims Despite 'Statutory' Violation Exclusion

"The court determined that the insurer failed to show that an exclusion barring coverage for claims arising out of ERISA and other securities laws violations was broad enough to bar coverage for accompanying common law claims of fraud and negligent misrepresentation." [Great American Fidelity Ins. Co. v. Stout Risius Ross, Inc., No. 19-11294 (E.D. Mich. Feb. 14, 2020)]

Hunton Andrews Kurth LLP

Workers Want Help with College Loans, Not 401(k)s

"Two-thirds of workers age 21 to 27 said their companies should help them pay down student loans, while just over a quarter, 27%, said employers should help workers save for retirement ... That sentiment isn't much different across age groups -- nearly 40% of all workers said that employers should help with student loan payments, while just 25% said the same for retirement plan contributions.... [P]eople who have low or no debt agreed with that nearly as much as those with high levels of debt[.]"

InvestmentNews; subscription may be required

Upcoming Events About Health & Welfare Plans

Feb. 25
Webcast
Reference-Based Pricing "Myths and Realities"
ISCEBS - Pacific NW Chapter
Feb. 25
Webcast
Effectively Managing Pharmacy Benefits: 5 Must Haves
Midwest Business Group on Health
Feb. 25
Texas
Employer's New Perk: Help Repaying Student Loan Debt
Worldwide Employee Benefits Network [WEB] - Dallas Chapter
Fee is required
Feb. 26
Webcast
Cost Differences for Oncology Medicines Based on Site of Treatment
EBRI [Employee Benefit Research Institute]
Feb. 27
Alabama
Regional Benefits Forum
Southeast Benefits Education Network [SBEN]
Fee is required

Most Popular Items in the Previous Issue

2020 ACA Compliance Checklist
Benefit Revolution

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David Rhett Baker, J.D., Editor and Publisher  davebaker@benefitslink.com
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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2020 BenefitsLink.com, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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